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Abstract Background The quality of communication in oncology significantly impacts patients' health outcomes, as poor communication increases the risk of unnecessary treatment, inadequate pain relief, higher anxiety levels, and acute hospitalizations. Additionally, ineffective communication skills training (CST) is associated with stress, low job satisfaction, and burnout among doctors working in oncology. While acknowledging the importance of effective communication, the specific features of successful CST remain uncertain. Role-play and recorded consultations with direct feedback appear promising for CST but may be time-consuming and face challenges in transferring acquired skills to clinical contexts. Our aim is to bridge this gap by proposing a novel approach: On-site Supportive Communication Training (On-site SCT). The concept integrates knowledge from previous studies but represents the first randomized controlled trial employing actual doctor-patient interactions during CST. Methods This randomized multicenter trial is conducted at three departments of oncology in Denmark. Doctors are randomized 1:1 to the intervention and control groups. The intervention group involves participation in three full days of On-site SCT facilitated by a trained psychologist. On-site SCT focuses on imparting communication techniques, establishing a reflective learning environment, and offering emotional support with a compassionate mindset. The primary endpoint is the change in percentage of items rated “excellent” by the patients in the validated 15-item questionnaire Communication Assessment Tool. The secondary endpoints are changes in doctors’ ratings of self-efficacy in health communication, burnout, and job satisfaction measured by validated questionnaires. Qualitative interviews will be conducted with the doctors after the intervention to evaluate its relevance, feasibility, and working mechanisms. Doctors have been actively recruited during summer/autumn 2023. Baseline questionnaires from patients have been collected. Recruitment of new patients for evaluation questionnaires is scheduled for Q1-Q2 2024. Discussion This trial aims to quantify On-site SCT efficacy. If it significantly impacts patients/doctors, it can be a scalable CST concept for clinical practice. Additionally, qualitative interviews will reveal doctors' insight into the most comprehensible curriculum parts. Trial registration April 2023 – ClinicalTrials.gov (NCT05842083). April 2023 – The Research Ethics Committee at the University of Southern Denmark (23/19397).

Martin Lund,1,&ast; Ditte Valsgaard Vammen,2,&ast; Milad Hanna,3 Søren Høyer,4 Lars Lund1,2,5 1Department of Urology, Odense University Hospital, Odense, Denmark; 2Department of Urology, Viborg Hospital, Viborg, Denmark; 3Department of Urology, Imperial College National Health Service Trust, London, UK; 4Department of Pathology, Aarhus University Hospital, Aarhus, Denmark; 5Clinical Institute, University of Southern Denmark, Odense, Denmark&ast;These authors contributed equally to this workCorrespondence: Lars Lund, Department of Urology, Odense University Hospital, Sdr. Boulevard 29, Odense, DK-5000, Denmark, Tel +45 5140 8982, Fax +45 6541 1726, Email Lars.Lund@rsyd.dkObjective: Low-energy extracorporeal shockwave therapy (LE-ESWT) has been shown to induce organ repair and neo-vascularization. The ability of LE-ESWT to improve erectile function in rodents as measured by improvements in intracavernosal pressure is well-established in various pathological situations. The underlying molecular mechanism are unclear and likely vary between different disorders, making rational drug design for synergetic effects with LE-ESWT difficult, without further research. In this placebo-controlled study, we aim to establish whether LE-ESWT can activate neovascularization biomarkers in diabetic tissues.Material and Methods: Forty Wistar rats, aged 8 weeks, were randomly divided into 4 groups: 8 untreated controls, 12 controls that underwent LE-ESWT treatment, 8 controls with induced diabetes mellitus (DM) and 12 with DM underwent LE-ESWT treatment. DM was induced by streptozotocin. LE-ESWT treatment was performed with a Duolith SD1 machine (Storz), with a total amount of energy of 6.4 J per treatment. The rats received a total of three LE-ESWT treatments with 2-week intervals between treatments.Results: Diabetic rats had significantly elevated blood glucose concentrations compared to control rats (P < 0.001) and experienced significant weight loss compared to controls (P < 0.001). Diabetic rats had elevated creatinine and urea and lower albumin (P < 0.001). Histologic analysis of penile tissue showed significant levels of vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF) expression in the LE-ESWT groups compared to controls (P< 0.01).Conclusion: LE-ESWT induces neo-angiogenesis as expressed by VEGF and FGF in erectile tissue in normal and diabetic rats.Keywords: erectile dysfunction, diabetes mellitus, extracorporeal shockwave therapy

Sune Moeller Skov-Jeppesen,1,2 Nicky Anúel Petersen,1 Knud Bonnet Yderstraede,2,3 Boye L Jensen,4 Claus Bistrup,2,5 Lars Lund1,2 1Department of Urology, Odense University Hospital, Odense, Denmark; 2Clinical Institute, University of Southern Denmark, Odense, Denmark; 3Department of Endocrinology, Odense University Hospital, Odense, Denmark; 4Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; 5Department of Nephrology, Odense University Hospital, Odense, DenmarkCorrespondence: Sune Moeller Skov-Jeppesen, Department of Urology, Odense University Hospital, Sdr. Boulevard 29, Odense, 5000, Denmark, Tel +45 51210911, Fax +45 65411726, Email sun_mjep@hotmail.comBackground: Low-intensity extracorporeal shockwave therapy (LI-ESWT) has been suggested as a treatment for vascular diseases such as ischemic heart disease, diabetic foot ulcers, and erectile dysfunction. Primarily, LI-ESWT is known for its ability to stimulate angiogenesis and activation of stem cells in target tissues. Application of LI-ESWT in chronic progressive renal diseases is a novel area. The aim of the present review was to summarize available data on the effects of LI-ESWT used in the setting of renal diseases.Methods: We systematically searched PubMed, Medline, and Embase databases for relevant studies. Our review included the results from preclinical animal experiments and clinical research.Results: Eleven animal studies and one clinical study were included in the review. In the animal studies, LI-ESWT was used for the treatment of hypertensive nephropathy (n=1), diabetic nephropathy (n=1), or various types of ischemic renal injury (ie, artery occlusion, reperfusion injury) (n=9). The clinical study was conducted in a single-arm cohort as a Phase 1 study with patients having diabetic nephropathy. In animal studies, the application of LI-ESWT was associated with several effects: LI-ESWT led to increased VEGF and endothelial cell proliferation and improved vascularity and perfusion of the kidney tissue. LI-ESWT reduced renal inflammation and fibrosis. LI-ESWT caused only mild side effects in the clinical study, and, similarly, there were no signs of kidney injury after LI-ESWT in the animal studies.Conclusion: LI-ESWT, as a non-invasive treatment, reduces the pathological manifestations (inflammation, capillary rarefaction, fibrosis, decreased perfusion) associated with certain types of renal disease. The efficacy of renal LI-ESWT needs to be confirmed in randomized clinical trials.Keywords: review, kidney disease, extracorporeal shockwave therapy, ESWT

Jan Krhut,1,2 Barbora Skugarevská,1,2 David Míka,1,2 Lars Lund,3,4 Peter Zvara3– 5 1Department of Urology, University Hospital, Ostrava, Czech Republic; 2Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic; 3Research Unit of Urology, Department of Clinical Research, University of Southern Denmark, Odense, Denmark; 4Department of Urology, Odense University Hospital, Odense, Denmark; 5Biomedical Laboratory, University of Southern Denmark, Odense, DenmarkCorrespondence: Jan Krhut, Department of Urology, University Hospital, T&rcaron; 17 Listopadu 1790, Ostrava 70852, Czech Republic, Tel +420 59-737-5307, Fax +420 59-737-5301, Email jan.krhut@fno.czAbstract: This nonsystematic review provides a summary of current evidence on the use of β3-adrenoreceptor agonists (β3-ARAs) for the treatment for lower urinary tract symptoms. Soon after their discovery in 1989, β3-ARs were identified as a predominant adrenoreceptor subtype in the human urinary bladder. Although it is widely believed that β3-ARAs cause detrusor relaxation, the effect on bladder afferent signaling likely plays an important role in their mechanism of action as well. In 2011 and 2012, mirabegron was approved for clinical use in overactive bladder (OAB) patients. Pooled analysis of data from prospective randomized studies on > 60,000 OAB patients showed that when compared to placebo, mirabegron was superior with respect to reducing the frequency, number, and severity of urgency episodes, number of incontinence episodes and increasing dry rate, but not in reduction of nocturia episodes. The only side effect showing significantly higher incidence than placebo was nasopharyngitis. Mirabegron is approved for OAB treatment in all age-groups and in pediatric patients with neurogenic bladder. Vibegron is another β3-ARA approved for OAB treatment in the US and Japan. Several large, multicenter, double-blind, randomized trials have documented statistically significant superiority of vibegron over placebo on all efficacy end points. Other β3-ARAs are being developed; however, to date none has been introduced to clinical use. All β3-ARAs provide efficacy similar to anticholinergics. They have a favorable safety profile and are well tolerated. Due to their different mechanisms of action, combination of β3-ARAs with anticholinergic compounds allows for increased efficacy.Keywords: urinary bladder, beta-mimetics, efficacy, safety, mirabegron, vibegron

Martin Lund,1 Torben B Pedersen,1 Søren Feddersen,2,3 Louise D Østergaard,1,3 Charlotte A Poulsen,1 Christian Enggaard,2 Mads HA Poulsen,1,3 Lars Lund1,3 1Department of Urology, Odense University Hospital, Odense, Denmark; 2Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark; 3Department of Clinical Research, University of Southern Denmark, Odense, DenmarkCorrespondence: Lars Lund, Department of Urology, Odense University Hospital, Sdr. Boulevard 29, Odense, 5000, Denmark, Tel +45 5140 8982, Fax +45 6541 1726, Email Lars.Lund@rsyd.dkPurpose: Serum levels of the polypeptide chemokine C-C motif ligand 2 (CCL2) have previously shown potential as a prostate cancer diagnostic and prognostic biomarker. Plasma CCL2 levels may be superior to serum levels as a biomarker because of their potentially lower signal-to-noise ratio.Materials and Methods: Before initiating a large comparative study of plasma and serum CCL2 levels, we performed a prospective, diagnostic pilot study Of 133 individuals from a clinically relevant population. CCL2 plasma levels were measured using a validated assay kit. Plasma was obtained independently of digital rectal examination.Results: In this pilot study, we found no relationship between CCL2 plasma values and risk of proven prostate cancer, whereas previous studies found a strong diagnostic relationship between CCL2 serum values and prostate cancer.Conclusion: Our contribution to the existing literature strengthens the idea that early in the pathological process, CCL2 mainly circulates in large, membrane-enclosed compartments, whereas plasma CCL2 levels increase markedly during disease progression. We conclude that whereas plasma CCL2 levels are not useful as a diagnostic measure, a ratio of CCL2 plasma to serum levels may prove useful as a marker of disease progression, which warrants further study.Keywords: diagnostics, liquid biopsy, CCL2, monocyte chemoattractant protein 1, MCP1

Jonas Mortensen,1 Sune Møller Skov-Jeppesen,1,2 Peter Bill Juul Ladegaard,1 Lars Lund1,2 1Department of Urology, Odense University Hospital, Odense, Denmark; 2Institute of Clinical Research, University of Southern Denmark, Odense, DenmarkCorrespondence: Jonas MortensenDepartment of Urology, Odense University Hospital, Sdr. Boulevard 29, Odense, 5000, DenmarkTel +45 40172260Email Jonas.Mortensen2@rsyd.dkPurpose: The aim of this study was to investigate whether ESWT with a higher energy as an add-on therapy to vacuum-pump followed by manipulation exercises could reduce the penile curvature, pain and improve IIEF-5 score.Materials and Methods: Men aged > 18 and < 80 years and diagnosed with PD in stable phase with no history of penile surgery or previous ESWT treatment were eligible to participate. They were randomised to either active ESWT (n = 16) or sham ESWT (n = 16). Both groups were treated once a week for five weeks. Each treatment session consisted of 2000 shockwaves at 0.5mJ/mm2. All patients in both groups used a vacuum pump followed by manipulation exercises.Results: Thirty men completed the study protocol. Mean age in the treatment group was 61.7 (SD 8.3) and 63 (SD 7.35) in the control group. After six months, mean change in penile curvature was − 12.8 (SD 13) degrees in the treatment group and − 6.6 (SD 8.9) in the control group (p = 0.204). Mean IIEF-5 score decreased by 0.17 (SD 3) in the treatment group and 3.06 (SD 5.5) in the control group (p = 0.086) at six-month follow-up. Pain was assessed using both VAS and PDQ and demonstrated no difference between the groups after six months (p = 0.648).Conclusion: In the treatment group, we observed a greater but non-significant change in penile curvature and no adverse effects.Keywords: Peyronie’s disease, ESWT, vacuum pump, erectile dysfunction, manipulation exercises

Sune Moeller Skov-Jeppesen,1– 3 Knud Bonnet Yderstraede,3,4 Boye L Jensen,5 Claus Bistrup,3,6 Milad Hanna,7 Lars Lund1,3 1Department of Urology, Odense University Hospital, Odense, Denmark; 2OPEN, Odense Patient data Explorative Network, Odense University Hospital, Odense, Denmark; 3Clinical Institute, University of Southern Denmark, Odense, Denmark; 4Department of Endocrinology, Odense University Hospital, Odense, Denmark; 5Department of Cardiovascular and Renal Research, Institute of Molecular Medicine, University of Southern Denmark, Odense, Denmark; 6Department of Nephrology, Odense University Hospital, Odense, Denmark; 7Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UKCorrespondence: Sune Moeller Skov-JeppesenDepartment of Urology, Odense University Hospital, Sdr. Boulevard 29, Odense C, 5000, DenmarkTel +45 51210911Fax +45 65411726Email sun_mjep@hotmail.comPurpose: Treatment with low-intensity shockwave therapy (LI-ESWT) is associated with angiogenesis and is suggested as a treatment for different types of vascular diseases. It was hypothesized that LI-ESWT improves the renal filtration barrier and halts the progression of GFR decline in diabetic kidney disease (DKD) potentially through VEGF and NO formation. We present the first data on LI-ESWT in human DKD.Methods: The study was designed as an interventional, prospective, one-arm, Phase 1 study. We investigated change in GFR and albuminuria in 28 patients with DKD treated with six sessions of LI-ESWT over three weeks. The patients were followed for six months. Urine excretion of kidney injury markers, vascular endothelial growth factor (VEGF) and nitric oxide metabolites (NOx) was studied after LI-ESWT.Results: There were no significant changes in GFR and albuminuria up to six months after LI-ESWT compared to baseline. Urine VEGF was transiently reduced one month after LI-ESWT, but there were no other significant changes in urine VEGF or NOx after LI-ESWT. Secondary analysis showed that NOx increased after LI-ESWT in patients who had low levels of NOx at baseline. Kidney injury marker trefoil factor 3 (TFF3) increased acutely after the first session of LI-ESWT indicating transient endothelial repair. Other markers of kidney injury were stable in relation to LI-ESWT.Conclusion: LI-ESWT treatment did not significantly improve kidney function and albumin excretion. It is concluded that LI-ESWT is not harmful. A randomized blinded study should be performed to clarify whether adjunctive treatment with LI-ESWT is superior to standard treatment of DKD.Keywords: albuminuria, clinical trial, diabetic kidney disease, glomerular filtration rate, ESWT, extracorporeal shockwave therapy

Stefan Artell Malaguti,1 Lars Lund1,2 1Department of Urology, Odense University Hospital, Odense, Denmark; 2Department of Clinical Research, University of Southern Denmark, Odense, DenmarkCorrespondence: Lars LundDepartment of Urology, Odense University Hospital, J.B.Winsløwsvej 4, Odense, 5000, DenmarkEmail Lars.Lund@rsyd.dkIntroduction: Chronic scrotal pain (CSP) can be a debilitating condition for patients and is often difficult to characterize.Methods: A review of literature was performed using Embase, Cochrane and Medline databases in the period 1.January 2010 to 1.January 2021. We found 132 articles, and the authors screened abstract and references. Thirty-seven articles are included after removing duplicates.Results: This review presents a variety of medical and surgical treatment options for CSP such as spermatic cord blocks (36– 80% success rate), microsurgical denervation of the spermatic cord (76– 100% success rates), Botox (56% success rate), targeted ilioinguinal and iliohypogastric peripheral nerve stimulation, and radical orchiectomy (55– 75% success rate).Conclusion: An overview of various treatment options, both non-surgical and surgical are provided, with the aim of establishing what may be the best treatment option for CSP.Keywords: scrotum, chronic, pain, testis

Bolette Danckert,1 Trine Allerslev Horsbøl,2 Ole Andersen,1 Susanne Oksbjerg Dalton,2,3 Jane Christensen,4 Margit Rasted,5 Astrid Petersen,6 Mette Nørgaard,7 Nessn Azawi,8 Lars Lund,9 Frede Donskov10 1Director´s Office, Danish Cancer Society Research Center, Copenhagen, Denmark; 2Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark; 3Department of Clinical Oncology & Palliative Care, Zealand University Hospital, Næstved, Denmark; 4Statistics and Data Analysis, Danish Cancer Society Research Center, Copenhagen, Denmark; 5Danish Health Data Authority, Copenhagen, Denmark; 6Department of Pathology, Aalborg University Hospital, Aalborg, Denmark; 7Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 8Department of Urology, Zealand University Hospital, Roskilde, Denmark; 9Department of Urology and Department of Clinical Research, University of Southern Denmark, Odense, Denmark; 10Department of Oncology, Aarhus University Hospital, Aarhus, DenmarkCorrespondence: Frede DonskovDepartment of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, Aarhus N 8200, DenmarkTel +45 4046 5234Email frede.donskov@auh.rm.dkBackground: The Danish multidisciplinary renal cancer group (DaRenCa) established the nationwide database DaRenCaData in 2010. The Danish Cancer Registry (DCR) has been considered the golden standard. In contrast to DCR, DaRenCaData required the diagnosis to be histologically or cytologically verified. DaRenCaData and DCR have not previously been compared.Patients and Methods: We included patients with renal cell carcinoma registered in DaRenCaData and/or DCR from August 1st 2010 to December 31st 2015. We computed completeness and positive predictive value (PPV) of a diagnosis in DaRenCaData compared with DCR, 1-year, 3-year and 5-year mortality rate ratios, and relative survival.Results: We identified 4890 patients in the two registries. Of these, 4326 were registered in DaRenCaData and 4714 in DCR. Completeness of DaRenCaData was 88% [95% CI, 87– 89%] and increased during the period from 82% to 94%. The PPV was 96% [95% CI, 95– 97%]. A total of 4150 patients (85%) were found in both registries, 4% (176 patients) in DaRenCaData only, and 12% (564 patients) in DCR only. The relative survival was higher for patients in DaRenCaData vs DCR; the 1-year and 5-year relative survival was 85% vs 81% and 65% vs 59%, respectively. Compared with patients registered in both registries, the mortality rates were higher in patients registered in DaRenCaData only (1-year hazard ratio (HR)=2.84 [95% CI, 2.20– 3.68]) or DCR only (1-year HR=4.29 [95% CI, 3.72– 4.93]). Observed in both registries, survival improved over time with a 7% yearly reduction in death based on estimations of 1-year mortality rate ratios.Conclusion: DaRenCaData had high and increasing completeness and high PPV, establishing it as a high-quality research database. Observed in both registries, renal cell carcinoma mortality declined over time; patients only registered in DCR or DaRenCaData had poorer outcomes. This study points to the importance of assessing the inclusion criteria when interpreting registry-based studies.Keywords: kidney cancer, national registries, survival, assessment of database

Andreas Pierre Hvolbek,1 Philip Mørkeberg Nilsson,2 Francesco Sanguedolce,3 Lars Lund1,3,41Department of Urology, Odense University Hospital, Odense, Denmark; 2Copenhagen Academy for Medical Education and Simulation, Rigshospitalet, University of Copenhagen and the Capital Region of Denmark, Copenhagen, Denmark; 3Department of Urology, Aalborg University Hospital, Aalborg, Denmark; 4Department of Clinical Research, University of Southern Denmark, Odense, DenmarkBackground: Robot-assisted surgery is a growing field. Prior video game experience might give advantage to novice robotic surgeons.Aim: Assessing if prior video gaming experience gives advantage in performing high-fidelity virtual reality (VR)-simulated robotic surgery.Methods: In this observational study, 30 medical students and 2 interns (17 females; 15 males) with median age 25 years (range, 24–26 years) were recruited and subsequently divided into groups according to prior gaming experience; gamers (≥6 video game hours/week) vs nongamers (6 hrs/week might give advantage in simulated robotic surgery. We recommend future studies testing this hypothesis to develop simulator programs for certification of robotic surgeons.Keywords: robot-assisted surgery, procedure specific, virtual reality, computer simulation, video game

Mads Hvid Poulsen,1,2 Jørn Skibsted Jakobsen,3 Mike Allan Mortensen,1,4 Poul Flemming Høilund-Carlsen,4,5 Lars Lund1,2,41Department of Urology, Odense University Hospital, Odense, Denmark; 2Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark; 3Department of Urology, Herlev and Gentofte University Hospital, Copenhagen, Denmark; 4Department of Clinical Research, University of Southern Denmark, Odense, Denmark; 5Department of Nuclear Medicine, Odense University Hospital, Odense, DenmarkObjective: The effect of curative treatment for oligometastatic prostate cancer patients is unsolved, both with regard to morbidity and mortality. With this study, we provide some of the first long-term follow-up data on progression and mortality in oligometastatic prostate cancer patients after curative treatment of their primary tumor.Methods: A cohort of 210 patients with diagnosed prostate cancer was established between 2008 and 2010. All patients were scheduled for intended curative treatment, and all underwent blinded 18F-choline positron-emission tomography/computed tomography at inclusion prior to curative treatment. Upon unblinding, 12 patients (6%) were recategorized as being oligometastatic. They had a mean age of 64 years,median prostate-specific antigen of 18 ng/mL, and median Gleason score of 7. Six patients were staged as T3, one T2, and five T1. The patients had a medianof one bone metastasis (range 1–2). All underwent intended curative radiotherapy or prostatectomy. Mean follow-up was 10.1 (8.9–11.0) years.Results: During follow-up of the 12 patients, three (25%) had biochemical recurrence, two developed castration-resistant disease, and one died due to prostate cancer.Conclusion: Our results suggest that intended curative treatment of the primary tumor in oligometastatic prostate cancer may have a role in highly selected patients.Keywords: prostate cancer, oligometastases, treatment

Lars Lund,1,2 Harry Nisen,3 Petrus Järvinen,3 Magnus Fovaeus,4 Eirikur Gudmundson,5 Bjarne Kromann-Andersen,6 Börje Ljungberg,7 Frode Nilsen,8 Pernilla Sundqvist,9 Peter E Clark,10 Christian Beisland11,12 1Department of Urology, Odense University Hospital, 2Clinical Institute, Southern University of Denmark, Odense, Denmark; 3Department of Urology, Helsinki University Hospital, Helsinki, Finland; 4Department of Urology, Sahlgrenska University Hospital, Gothenburg, Sweden; 5Department of Urology, Landspitali University Hospital, Reykjavik, Iceland; 6Department of Urology, Herlev University Hospital, Copenhagen, Denmark; 7Department of Surgical and Perioperative Sciences, Urology and Andrology, Umeå University, Umeå, Sweden; 8Department of Urology, Akershus University Hospital, Lörenskog, Norway; 9Department of Urology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 10Department of Urology, Atrium Health, Charlotte, NC, USA; 11Department of Urology, Haukeland University Hospital, 12Department of Clinical Medicine, University of Bergen, Bergen, Norway Purpose: To examine the variation in venous thromboembolism prophylactic treatment (VTEP) among renal cancer patients undergoing surgery.Materials and methods: An Internet-based questionnaire on renal tumor management before and after surgery was mailed to all Nordic departments of urology. The questions focused on the use of VTEP and were subdivided into different surgical modalities.Results: Questionnaires were mailed to 91 institutions (response rate 53%). None of the centers used VTEP before surgery, unless the patient had a vena caval tumor thrombus. Overall, the VTEP utilized during hospitalization for patients undergoing renal surgery included early mobilization (45%), compression stockings (52%) and low-molecular-weight heparin (89%). In patients undergoing open radical Nx, 80% of institutions used VTEP during their hospitalization (23% compression stockings and 94% low-molecular-weight heparin). After leaving the hospital, the proportion and type of VTEP received varied considerably across institutions. The most common interval, used in 60% of the institutions, was for a period of 4 weeks. The restriction to the Nordic countries was a limitation and, therefore, may not reflect the practice patterns elsewhere. It is a survey study and, therefore, cannot measure the behaviors of those institutions that did not participate.Conclusion: We found variation in the type and duration of VTEP use for each type of local intervention for renal cancer. These widely disparate variations in care strongly argue for the establishment of national and international guidelines regarding VTEP in renal surgery. Keywords: venous-thrombotic-embolic prophylaxis kidney cancer, surgery, nephrectomy, mortality, complication, minimally invasive methods, thrombosis prophylaxis

Morten Steen Svarer Hansen,1 Niels Jacobsen,1 Anja Lisbeth Frederiksen,2 Lars Lund,3 Marianne Skovsager Andersen,1 Dorte Glintborg1 1Department of Endocrinology and Metabolism, 2Department of Clinical Genetics, 3Department of Urology, Odense University Hospital, Odense, Denmark Abstract: Recent guidelines recommend consideration of genetic screening in all newly diagnosed patients with pheochromocytoma. Patients diagnosed with pheochromocytoma in the Region of Southern Denmark during 2006–2013 without previously recognized monogenetic etiology were offered genetic screening for mutations in the VHL, RET, SDHB, SDHC, and SDHD genes. A total of 41 patients were included, and genetic data were available in 35. In four of the 35 patients, a pathogenic variant was identified prior to the diagnosis of pheochromocytoma (von Hippel–Lindau disease, n=2; neurofibromatosis type 1, n=2). The patients carrying a genetic mutation were all younger than 45 years at time of diagnosis of pheochromocytoma, two patients presented with bilateral tumors, and one patient had a positive family history of pheochromocytoma. Genetic screening of the remaining 31 patients did not identify any mutations. The sporadic cases had a median age of 58 years (range 33–80 years). Three of 31 sporadic cases (ages 60, 69, and 76 years at time of diagnosis) presented with bilateral adrenal tumors, one patient had multiple adrenal tumors in both adrenal glands, and no patients had a positive family history of pheochromocytoma. Of the 31 patients, 24 (68.6%) were diagnosed with pheochromocytoma due to evaluation of an adrenal incidentaloma. In conclusion, monogenetic etiology was identified in four of 35 (11.4%) patients diagnosed with pheochromocytoma. Keywords: pheochromocytoma, genetic screening, guidelines, adrenal incidentaloma

Jennifer Lindberg,1 Emilie Rickardsson,1 Margrethe Andersen,2 Lars Lund1,2 1Clinical Institute, University of Southern Denmark, Odense, 2Department of Urology, Odense University Hospital, Odense C, Denmark Objective: To establish an animal model of a vesicovaginal fistula that can later be used in the development of new treatment modalities.Materials and methods: Six female pigs of Landrace/Yorkshire breed were used. Vesicotomy was performed through open surgery. An standardized incision between the bladder and the vagina was made, and the mucosa between them was sutured together with absorbable sutures. A durometer ureteral stent was introduced into the fistula, secured with sutures to the bladder wall, allowing for the formation of a persistent fistula tract. Six weeks postoperatively cysto-scopy was performed to examine the fistula in vivo. Thereafter, the pigs were euthanized with intravenous pentobarbital.Results: Two out of four (50%) pigs developed persistent fistulas. No per- or postoperative complications occurred.Conclusion: This study indicates that this pig model of vesicovaginal fistula can be an effective and cheap way to create a fistula between the bladder and vagina. Keywords: vesicovaginal fistula, urinary fistula, animal model

Lars Lund,1,2 Niels Svolgaard,1 Mads Hvid Poulsen1 1Department of Urology, Odense University Hospital, 2Clinical Institute, Southern University of Southern Denmark, Odense, Denmark Abstract: The objective of this paper is to review the current recommendations for active surveillance in prostate cancer from the present prospective studies. Worldwide, there are increasing numbers of men with prostate cancer. It is now accepted as standard care that a number of men with favorable-risk disease can be followed with active surveillance. In 1995, the first prospective studies were initiated to assess the feasibility of active surveillance, in which the decision to intervene was determined by prostate-specific antigen and/or histological progression. The strategy was to provide therapy individualized to the biological behavior of the cancer. Clinical trials assessing active surveillance have usually included patients younger than 70 years of age, although the guidelines have changed over time for Gleason score and prostate-specific antigen, eg, doubling time, thereby changing the indication for active treatment. The present review focuses on patient selection, prospective studies reported in the literature, and future directions. Keywords: active surveillance, prostate cancer, prospective studies, review

Tau Pelant1,2, Erik Højkjær Larsen1,2, Lars Lund3, Michael Borre4, Rune Erichsen1, Mette Nørgaard1, Jacob Bonde Jacobsen11Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; 2Department of Urology, Aarhus University Hospital, Aalborg, Denmark; 3Department of Urology, Viborg Hospital, Denmark; 4Department of Urology, Aarhus University Hospital, Skejby, DenmarkObjective: For decades, kidney cancer patients in Denmark have had lower survival than patients in the other Scandinavian countries. Our aim was to study possible changes in survival of patients with kidney cancer after implementation of two national Danish cancer plans.Study design and setting: From 1998 through 2009 we included all patients (N = 2659) with an incident diagnosis of kidney cancer in two Danish regions (population 1.8 million). Data were retrieved from the Danish National Registry of Patients. We computed survival after 1, 3, and 5 years, stratified by age, and estimated mortality rate ratios (MRRs) using Cox regression to assess changes over time, controlling for age and gender. We lacked data on stage distribution. Among patients who had a nephrectomy we also computed 30-day mortality and 30-day MRRs.Results: During the study period, we identified 2659 patients with kidney cancer. The annual number of patients increased from 583 in the period 1998–2000 to 853 in the period 2007–2009. The median age at diagnosis was 69 years throughout the study period. The overall 1-year survival improved from 56% (1998–2000) to 63% (2007–2009), corresponding to an adjusted MRR of 0.78 (95% confidence interval [CI] 0.66–0.93). We predicted the 3-year survival to increase from 40% to 51% and the 5-year survival to increase from 33% to 42%, corresponding to predicted MRRs of 0.76 (95% CI 0.66–0.87) and 0.77 (95% CI 0.68–0.89), respectively. Survival increased in all age groups (15–59 years, 60–74 years, 75+ years) and in both genders, except for men below 60 years, for whom the 1-year survival declined from 76% to 69%. The 30-day mortality after nephrectomy declined from 4% to 2% during the study period.Conclusion: We observed an improvement in the survival and relative mortality in kidney cancer patients, although not in men younger than 60 years.Keywords: kidney neoplasm, outcome research, mortality rate ratio, MRR

Michael Borre1,2, Rune Erichsen1, Lars Lund3, Erik Højkjær Larsen4, Mette Nørgaard1, Jacob Bonde Jacobsen11Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; 2Department of Urology, Aarhus University Hospital, Skejby, Denmark; 3Department of Urology, Region Hospital Viborg, Denmark; 4Department of Urology, Aarhus University Hospital, Aalborg, DenmarkObjective: Prostate cancer is the most common noncutaneous cancer among Danish men. During the last decade, use of prostate specific antigen (PSA) testing has increased, and in clinically localized prostate cancer, curative intended treatment has gained a footing. Our aim was to examine possible changes in the short- and long-term survival of patients with prostate cancer during 1998–2009.Study design and setting: From two Danish regions (population, 1.8 million) we included all patients (N = 10,547) with an incident diagnosis of prostate cancer retrieved from the Danish National Registry of Patients. We determined survival after 1, 3, and 5 years, stratified by age, and estimated mortality rate ratios (MRRs) using Cox proportional hazard regression to assess changes over time, controlling for age.Results: During the study period, the annual number of incident prostate cancer patients more than doubled, and the median age at diagnosis decreased from 74 to 70 years. The survival improved over the study period, particularly in the last half of the period (2004–2009). Thus, 1-year survival increased from 80% (1998–2000) to 90% (2007–2009), corresponding to an age-adjusted MRR of 0.54 (95% confidence interval CI: 0.46–0.63). The expected increase in 3- and 5-year survival was even more pronounced: 47%–73% and 34%–60%, respectively. This corresponded to a 3-year age-adjusted MRR of 0.46 (95% CI: 0.42–0.51) and a 5-year MRR of 0.50 (95% CI: 0.46–0.54). The 1-, 3-, and 5-year overall survival increased in all age groups (

Lars Lund1,2, R Erichsen1, M Nørgaard1, E H Larsen3, M Borre4, J Jacobsen11Department of Clinical Epidemiology, Aarhus University Hospital, Denmark; 2Department of Urology, Viborg Hospital, Denmark; 3Department of Urology, Aarhus University Hospital, Aalborg, Denmark; 4Department of Urology, Aarhus University Hospital, Skejby, DenmarkObjective: Invasive bladder cancer (IBC) is a common urological malignancy accounting for 4%–5% of all cancers in Denmark. Our aim was to examine possible changes in short- and long-term survival of patients with IBC during 1998–2009.Study design and setting: Data on all patients (N = 4032) with an incident diagnosis of IBC within a population of 1.8 million were retrieved from the Danish National Registry of Patients from 1998 to 2009. We computed survival after 1, 3, and 5 years, stratified by age and gender, and estimated mortality rate ratios (MRR) using Cox proportional hazard regression to compare mortality over time, controlling for age and gender. Data on tumor stage or histology were not included.Results: During the study period, the annual numbers of incident IBC patients remained stable. The median age was 74 years in each of the four 3-year periods in the study. The survival was relatively stable during the first three periods, whilst data from the last period showed modest improvement. The overall 1-year survival increased from 68% in 1998–2000 to 70% in 2007–2009, corresponding to an age and gender adjusted MRR of 0.89 (95% confidence interval [CI] 0.76–1.03). The 3- and 5-year survival was predicted to increase from 44% to 49% and from 35% to 40% respectively. This corresponded to a 3-year age and gender adjusted MRR of 0.87 (95% CI 0.77–0.98) and a 5-year MRR of 0.88 (95% CI 0.79–0.99). The 1-, 3-, and 5-year survival increased for men in all age groups (

This study reviews the research literature on blue health promotion and the value of multiple forms of coastal and marine recreation and activities across societal contexts, with contributions from the Nordic region. It re-emphasizes the need for interrogating whose benefits and interests are promoted and the diversity of physical cultures and activities. The conceptualisation of "salutogenetic" health interventions contextualises the review beyond individualised and medicalised scopes through the research question: "Whether and how does integrated coastal and marine planning and management seek to facilitate and enhance physically active blue health promotion that is also socio-ecologically inclusive?" Following the scoping review framework by Arksey and O'Malley (2005), the study identifies recent research and gaps through an iterative process. It employs transparency on inclusion/exclusion criteria, and in the comparison and discussion concerning methodology and findings. The research techniques included searches across online databases, journals, library resources, and manually scanning reference lists and abstracts. The peer-reviewed works included are n = 58 published between 1996 and 2022, with most published between 2015 and 2022. The reviewed literature is grouped analytically into two themes: (1) Blue health promotion, interventions and activities and (2) integrated marine planning, management and policy. Against this background, the article discusses the potential of a complementary research approach combining: (a) the "salutogenetic" orientation, (b) formative interventions and (c) co-creation in blue health promotion practices. Findings suggest a need for greater differentiation concerning a socio-ecological approach to recreational blue health promotion, prioritizing locally tailored and seasonally adapted interventions.

The significance of the study comes in the fact that it investigates complex fluid dynamics and magnetohydrodynamics phenomena, which have the potential to be applied in a variety of domains, such as physics, engineering, and materials science. Their exceptional physical significance stems from their ability to combine the unique properties of multiple substances to provide the desired functions and performance characteristics. However, in this study, the numerical studies of slip effects on magnetized radiatively hybridized ferrofluid flow with acute magnetic force over stretching/shrinking surface were investigated. The main objective of current research is to examine the influence of solid volume percentage of cobalt ferrite, the sharply oriented magnetic field, and velocity slip factors on the behaviour of skin friction and heat transfer subjected to suction effect. Moreover, the study included an analysis of the behaviour of velocity and temperature profiles in relation to the consideration of the magnetic parameter, the solid volume percentage of cobalt ferrite, the Prandtl number, and the thermal radiation parameter. The equations that regulate the system were converted partial differential equations into ordinary differential equations by making use of the relevant similarity variables, and then, it solved with bvp4c MATLAB software. The boundary requirements are satisfied in particular parameter ranges where dual solutions are achieved. Besides, dual solutions were obtained in shrinking zone. At critical points, the two dual solutions intersect; however, after these points, no further solutions are accessible. The heat transfer rate decreased the velocity slip factor, while it increased the thermal slip factor. In addition, the thickness of the thermal boundary layer increased thermal radiation, while simultaneously reducing the Prandtl number. Besides, the temperature profile improves when the value of cobalt ferrite is higher. In summary, according to stability analysis, he first solution is stable and the second solution is unstable.